Acta neurochirurgica
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Acta neurochirurgica · Feb 2010
EditorialTrigeminal neuralgia: a plea for microvascular decompression as the first surgical option. Anatomy should prevail.
Arguments are given to plead why micro-vascular decompression should be the first surgical option to treat primary trigeminal neuralgias resistant to anticonvulsants.
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Acta neurochirurgica · Feb 2010
Genes influencing coagulation and the risk of aneurysmal subarachnoid hemorrhage, and subsequent complications of secondary cerebral ischemia and rebleeding.
We investigated whether genes influencing coagulation are associated with the occurrence of aneurysmal subarachnoid hemorrhage (SAH) and with secondary cerebral ischemia and rebleeding in patients with aneurysmal SAH. ⋯ We found that aneurysmal SAH patients are more often carriers of the subunit B His95Arg factor XIII polymorphism compared to controls. This suggests that carriers of the subunit B His95Arg factor XIII polymorphism have an increased risk of aneurysmal SAH. Larger studies should confirm our results. As aneurysmal SAH patients who died soon after admission could not be included in the present study, our results only apply to a population of patients who survived the initial hours after the hemorrhage. For the other studied genetic factors involved in coagulation, no association with the occurrence of aneurysmal SAH or with the occurrence of secondary cerebral ischemia or rebleeding after aneurysmal SAH could be demonstrated.
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Acta neurochirurgica · Feb 2010
Clinical and surgical features of lower brain stem hemangioblastomas in von Hippel-Lindau disease.
In the context of von Hippel-Lindau disease (VHL), the medulla oblongata is a relatively frequent site of growth of hemangioblastomas, posing related clinical and surgical difficulties. Their management requires a close correlation between clinical evolution and morphological surveillance. In order to describe their clinical and surgical features, we reviewed our experience in the treatment of these lesions. ⋯ Lower brain stem hemangioblastomas in the context of VHL show an often gradual onset of signs and symptoms except for patients who develop an obstructive hydrocephalus. Although transient surgical complications are possible, surgery provides favorable long-term results.
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Acta neurochirurgica · Feb 2010
Case ReportsCystic craniopharyngioma: trans-sphenoidal surgery and intra-cystic apposition of "bleomycin wax".
The current therapeutic approach to craniopharyngioma is multidisciplinary. Sub-total removal, followed by adjuvant treatments, especially in large cystic tumours, is an accepted regime reported by many authors. ⋯ The intra-operative use of "bleomycin-wax" should be limited to those patients in whom intra-operative CSF fistula does not occur.
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The parasellar region is a small but complex structure, and a large variety of tumors arise from this region. Postoperative morbidity for these tumors depends significantly on the cranial nerves located in the lateral part of this parasellar region. The aim of this study is to understand the anatomical structures of the lateral parasellar region and describe the inter-dural approach for parasellar tumors. ⋯ Considering anatomical and histological study and our clinical experiences, this inter-dural approach is practicable and useful for surgical removal of the tumors such as trigeminal neurinoma and cavernous hemangioma.